The association of pregestational and gestational diabetes with severe neonatal morbidity and mortality

Objective To estimate the association between maternal diabetes and severe neonatal morbidity. Study design Retrospective cohort study of nonanomalous neonates born 24(0)-41(6) weeks' gestation from two large multisite U.S. cohorts, Cesarean Registry and Consortium on Safe Labor. The exposure was pregestational versus gestational versus no diabetes. The composite neonatal outcome included respiratory distress syndrome, mechanical ventilation, necrotizing enterocolitis, grade 3-4 intraventricular hemorrhage, and death. Multivariable logistic regression estimated the association between diabetes and neonatal morbidity. Result Of 196,006 eligible neonates, 2993 (1.5%) were born to mothers with pregestational diabetes and 10,549 (5.4%) with gestational diabetes. Pregestational diabetes was associated with higher odds of neonatal morbidity versus gestational diabetes (aOR 2.27, 95% CI 1.95-2.64), as well as no diabetes (aOR 1.96, 95% CI 1.63-2.35). Gestational diabetes was associated with higher odds of neonatal morbidity versus no diabetes (aOR 1.16, 95% CI 1.04-1.30). Conclusion Pregestational and gestational diabetes are risk factors for severe neonatal morbidity.